We evaluated the effects of dietary NDF concentration from alfalfa hay and bulk density of steam- flaked corn (SFC) on growth performance, carcass characteristics, and liver abscesses in finishing ...beef steers.
Crossbred beef steers (n = 214; 60 pens; initial BW = 417 ± 11.9 kg) were blocked by BW and assigned randomly to treatments and fed an average of 112 d. The treatments were arranged as a 2 × 3 factorial with 10 pens per treatment and consisted of 3 NDF concentrations from alfalfa hay (3%, 4.5%, or 6%) and 309 g/L (24 lb/bu) or 412 g/L (32 lb/bu) SFC (69% or 33% starch availability, respectively). Growth performance and carcass data were analyzed with PROC MIXED of SAS with pen as the experimental unit. Quality grades and liver scores were analyzed as binomial proportions using PROC GLIMMIX. Contrast statements were used to separate linear and quadratic effects of increasing roughage NDF.
Dry matter intake responded quadratically from d 0 to 35 as roughage NDF increased from 3% to 6%, and DMI increased linearly as roughage NDF increased on d 70 to 105 and d 0 to final. Otherwise, no differences in growth performance were noted. Marbling score responded quadratically to roughage level and was greater for steers fed 3% than for those fed 4.5% or 6% roughage NDF. Steers fed 309 g/L SFC tended to have a larger LM area than those fed 412 g/L SFC. The total percentage of abscessed livers at slaughter decreased linearly as roughage NDF was increased from 3% to 6% of DM as did the presence of A+ abscesses. In addition, total liver abscesses were 13.9 percentage points less in steers fed 412 versus 309 g/L SFC.
Results suggest that increasing roughage NDF and bulk density of SFC are dietary strategies that can decrease the presence of liver abscesses at slaughter without negatively affecting growth performance.
A direct numerical simulation of fully developed turbulent flow in a channel is used to study passive scalar transport in the immediate vicinity of a wall. The Reynolds number, based on the channel ...half-height and friction velocity, is 150 and the Prandtl number is varied from 1 to 10. DNS results and experimental measurements of mass transfer rates at high Schmidt numbers are used to investigate the effect of Schmidt or Prandtl number. The wavenumber spectra for temperature fluctuations show a damping of the contributions of large wavenumbers with increasing Schmidt or Prandtl number. This result suggests that the analogy between momentum and scalar transport cannot be used to define the limiting behavior of turbulent diffusivity for
y→0. Furthermore, this limiting relation cannot be used to calculate the concentration or temperature profile since it is applicable only in the conductive sublayer, where turbulent transport is not important.
Percutaneous coronary intervention (PCI) is increasingly used in revascularisation of patients with left main coronary artery disease in place of the standard treatment, coronary artery bypass ...grafting (CABG). The NOBLE trial aimed to evaluate whether PCI was non-inferior to CABG in the treatment of left main coronary artery disease and reported outcomes after a median follow-up of 3·1 years. We now report updated 5-year outcomes of the trial.
The prospective, randomised, open-label, non-inferiority NOBLE trial was done at 36 hospitals in nine northern European countries. Patients with left main coronary artery disease requiring revascularisation were enrolled and randomly assigned (1:1) to receive PCI or CABG. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, repeat revascularisation, and stroke. Non-inferiority of PCI to CABG was defined as the upper limit of the 95% CI of the hazard ratio (HR) not exceeding 1·35 after 275 MACCE had occurred. Secondary endpoints included all-cause mortality, non-procedural myocardial infarction, and repeat revascularisation. Outcomes were analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT01496651.
Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were enrolled and allocated to PCI (n=598) or CABG (n=603), with 17 subsequently lost to early follow-up. 592 patients in each group were included in this analysis. At a median of 4·9 years of follow-up, the predefined number of events was reached for adequate power to assess the primary endpoint. Kaplan-Meier 5-year estimates of MACCE were 28% (165 events) for PCI and 19% (110 events) for CABG (HR 1·58 95% CI 1·24–2·01); the HR exceeded the limit for non-inferiority of PCI compared to CABG. CABG was found to be superior to PCI for the primary composite endpoint (p=0·0002). All-cause mortality was estimated in 9% after PCI versus 9% after CABG (HR 1·08 95% CI 0·74–1·59; p=0·68); non-procedural myocardial infarction was estimated in 8% after PCI versus 3% after CABG (HR 2·99 95% CI 1·66–5·39; p=0·0002); and repeat revascularisation was estimated in 17% after PCI versus 10% after CABG (HR 1·73 95% CI 1·25–2·40; p=0·0009).
In revascularisation of left main coronary artery disease, PCI was associated with an inferior clinical outcome at 5 years compared with CABG. Mortality was similar after the two procedures but patients treated with PCI had higher rates of non-procedural myocardial infarction and repeat revascularisation.
Biosensors.
Summary Background Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary ...intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main coronary artery disease. Methods In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1:1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST-elevation myocardial infarction. Exclusion criteria were ST-elevation myocardial infarction within 24 h, being considered too high risk for CABG or PCI, or expected survival of less than 1 year. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, any repeat coronary revascularisation, and stroke. Non-inferiority of PCI to CABG required the lower end of the 95% CI not to exceed a hazard ratio (HR) of 1·35 after up to 5 years of follow-up. The intention-to-treat principle was used in the analysis if not specified otherwise. This trial is registered with ClinicalTrials.gov identifier, number NCT01496651. Findings Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were randomly assigned, 598 to PCI and 603 to CABG, and 592 in each group entered analysis by intention to treat. Kaplan-Meier 5 year estimates of MACCE were 28% for PCI (121 events) and 18% for CABG (80 events), HR 1·51 (95% CI 1·13–2·00), exceeding the limit for non-inferiority, and CABG was significantly better than PCI (p=0·0044). As-treated estimates were 28% versus 18% (1·48, 1·11–1·98, p=0·0069). Comparing PCI with CABG, 5 year estimates were 11% versus 9% (1·08, 0·67–1·74, p=0·84) for all-cause mortality, 6% versus 2% (2·87, 1·40–5·89, p=0·0040) for non-procedural myocardial infarction, 15% versus 10% (1·50, 1·04–2·17, p=0·0304) for any revascularisation, and 5% versus 2% (2·20, 0·91–5·36, p=0·08) for stroke. Interpretation The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease. Funding Biosensors, Aarhus University Hospital, and participating sites.
Is the depiction of loneliness as a public health issue evidence-based? In this presentation, we critically review the epidemiological literature linking the subjective feeling of loneliness (as ...opposed to the more objective situation of social isolation) to morbidity and mortality. Using a) the ‘Grades of Recommendation, Assessment, Development, and Evaluation’ guidance and b) Gordis’ guidelines for assessing evidence of causation, we assess the quality of the evidence across physical and mental health outcomes, and across different study designs and populations. This process allows us to consider the main challenges facing epidemiologists, which include: disentangling the direction of causality; distinguishing between confounding, mediating and moderating factors; and identifying at-risk groups and opportunities for intervention. We will discuss the implications of uncertainty in the field for users of evidence (campaigners, policy-makers, practitioners and other stakeholders), and will conclude the presentation with suggestions for how me might strengthen the evidence base.
BackgroundLoneliness, understood as the negative feeling experienced by those who perceive their social relationships to be deficient, and social isolation, characterised by the relative absence of ...contact with others, have recently been identified as a public health challenge in the United Kingdom. How is this social «problem» defined, who is expected to tackle it, and how? These are the questions we explore in our presentation.MethodsWe used Bacchi’s (2009) ‘What’s the problem represented to be?’ framework, informed by Foucault's theory of governmentality and methods of problematization, archaeology and genealogy, to analyse the way in which the issue of loneliness and social isolation is represented in British policy. Taking the 2012 White Paper «Caring for our Future: Reforming care and support» as our starting point, we used discourse analysis to identify the assumptions of the public health strategy currently being promoted.ResultsWe identified three main assumptions: 1) being lonely or socially isolated is perceived to be particularly problematic in older age; 2) loneliness and social isolation are targeted as factors whose potential effects on health can be modified; 3) the involvement of civil society is identified as key to the delivery of interventions aimed at strengthening the social relationships of isolated individuals. We show how these assumptions shape the prevention strategies currently promoted, and what they omit. In particular, we discuss how the current focus on secondary and tertiary prevention ignores important dynamics such as lifecourse trajectories and social determinants of health.ConclusionActively questioning the representation of the «problem» of loneliness and social isolation in British policy allows us to shed light on the limitations of the intervention approach currently pursued. In particular, it highlights the absence of primary intervention initiatives, which are key to an effect prevention strategy.
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